The Cincinnati Health Department, some local hospitals and several federally qualified health centers are scrambling to line up medical services for about 19,000 needy patients after the sudden closure of Neighborhood Health Care Inc.

Four neighborhood health centers in Greater Cincinnati were closed Dec. 30 after a federal grant wasn’t renewed for 2014, leaving thousands of uninsured or underinsured patients without medical services provided at the centers operated by Neighborhood Health Care Inc.

The agency had struggled for several years to manage debts while operating health centers in downtown Cincinnati, Walnut Hills, Norwood and Harrison.

Neighborhood Health Care Inc. was notified Dec. 17 that it wouldn’t receive a $1.2 million grant to help fund its 2014 operations from the U.S. Health Resources and Services Administration (HRSA). That prompted the decision to close the neighborhood health centers as well as school-based health center programs at Rockdale Academy, South Avondale and the Hughes Center in the Cincinnati Public Schools system.

The grant accounted for about 13.6 percent of Neighborhood Health Care Inc.’s $8.8 million budget, but operations couldn’t be sustained without the federal funding, said Sher McClanahan, chairwoman of the agency’s board of directors.

The offer of a $440,000, four-month extension in funding by the HRSA wouldn’t cover monthly operating expenses, vendor debt that prevented delivery of required supplies and services, and requirements of a bank loan debt of more than $2 million, McClanahan said.

Now, emergency rooms at local hospitals could see a surge in requests for treatment from patients who had been treated at the closed health centers, and that could prove expensive for taxpayers and health systems.

“I am absolutely convinced there is not the capacity to absorb these patients with the continuity of care we want them to have,” McClanahan said.

The closed centers handled more than 1,000 patient visits a week, McClanahan said.

Other health care providers don’t have the resources to immediately absorb such a big influx of patients, said Rocky Merz, spokesman for the Cincinnati Health Department.

It might take at least four months to coordinate care for the working men and women with families who were patients, some of whom have chronic conditions and need medications for heart problems or illnesses such as diabetes, Merz said. Also left vulnerable are pregnant women who had been receiving prenatal care.

In addition, left without jobs were about 65 people who worked for the nonprofit Neighborhood Health Care Inc., including doctors, nurses and dentists. Several recruiters from TriHealth, which operates four hospitals in Greater Cincinnati, were to interview those interested in finding new jobs, said McClanahan, who is a senior vice president of TriHealth.

The situation might have been avoided if some of the same officials now trying to find a remedy hadn’t opposed a merger between Cincinnati-based Neighborhood Health Care Inc. and HealthPoint Family Care of Covington, McClanahan said.

HealthPoint’s CEO, Chris Goddard, said the Kentucky nonprofit had spent more than $200,000 to cover supplies such as bandages “and countless management hours” helping out Neighborhood Health Care Inc. with the intent of assuming administrative oversight.

Goddard had served as interim CEO of Neighborhood Health Care Inc. for several months, McClanahan said. She was optimistic that, following a merger, Goddard could correct previous problems involving billing and management of the agency.

“We had developed a five-year plan that would provide the ability to pay off our debts,” McClanahan said. “We had been having conversations with HRSA since July about our need for a financial recovery plan, and that included the ability to merge with HealthPoint.”

However, the CEOs of five agencies in Southwest Ohio, including Joyce Tate of the Cincinnati Health Department, signed an Oct. 14 letter expressing “grave concerns over the potential merger” to the federal agency that administers the grant money that helped fund the operations of Neighborhood Health Care Inc.

“The appearance or possibility of a Kentucky-based (federally qualified health center) coming into Ohio and competing for federal grant funds that have historically been earmarked for Ohio will have serious implications for not only us but also other states and cities across the country,” states the letter to Jim McRae, associate administrator for primary health care with the Health Resources and Services Administration, which is part of the U.S. Department of Health and Human Services.

The letter was signed by Tate as well as CEOs Dolores Lindsay of the Health Care Connection, Miriam Crenshaw of the Walnut Hills Medical and Health Center, Sally Stewart of Christian Community Health Services Inc. (commonly known as the Crossroad Health Center) and Kate Bennett of the Cincinnati Health Network.

“It’s difficult to understand the motivation behind the letter,” said McClanahan.

While the matter appears to involve nonprofit agencies vying for federal funding, “I would not characterize it as a turf war,” said Merz, the spokesman for the Cincinnati Health Department. “Our concern is with the patients not having access to care. Nobody here in the community suggested Neighborhood (Health Care Inc.) should close in any way, shape or form. Questions were raised about the merger.”

In addition, letters of concern about the proposed merger apparently were sent to several federal elected officials who represent Ohio by the president of the NAACP’s Cincinnati chapter, Jim Clingman, and the CEO of the Urban League of Greater Cincinnati, Donna Jones Baker.

“We have concerns about Ohio’s federal dollars going outside of Ohio to Kentucky, (and) the potential negative health consequences of an out-of-state based entity … delivering health services to an urban population,” stated a Nov. 27 letter signed by Clingman and Jones to U.S. Sen. Sherrod Brown.

“We would like to draw your attention to a letter signed by ALL of the CEOs from the city of Cincinnati and Hamilton County (federally qualified health centers), protesting the planned merger,” the letter from the NAACP and Urban League officials stated. “A prudent short term solution would be to temporarily ‘assign’ full fiscal and operational responsibility to a current city of Cincinnati or Hamilton County (federally qualified health center).”

McClanahan said she and other board members at Neighborhood Health Care Inc. were shocked by the federal government’s rejection of the reapplication for funding and she believed the grant administrators might have been influenced by the letters from the local CEOs and civic leaders.

“What they failed to recognize is that the money would never go across the river (to Kentucky),” McClanahan said. “You apply for the grant for the people you’re serving. Is the location of the administrative office more important than the people being served?”

Martin Kramer, a spokesman for HRSA, said he couldn’t comment on why Neighborhood Health Care Inc. didn’t qualify for a grant renewal. He also said the agency doesn’t discuss conversations held with the offices of members of Congress, or letters such as those sent by the Cincinnati CEOs who opposed the merger. A competition will be held, and the grant money could be awarded in April to one of the five other federally qualified health centers in the Cincinnati area, he said.

“I do think part of the concern for some is keeping health care dollars in Ohio,” Valarie Molaison, an aide to Brown, wrote in an email to McClanahan. “And yet HRSA was clear with me that they do not recognize state lines; their mission is to award grants to providers who can show that they will be able to provide the services.”

Officials with Cincinnati Children’s Hospital Medical Center and the University of Cincinnati Medical Center are among the health care providers trying to come up with solutions, Merz said. One of the concerns is providing care for children who had been served at the school-based health centers.

“We’ve all been meeting and figuring out how do we ensure that services are provided in the short term,” Merz said. “We’re getting a lot of calls from patients looking for appointments. We are making slots available starting Monday (Jan. 6). We don’t know how many will show up. They can call 513-357-7320. We’ll get them on a list and get them in.”

However, other agencies might have to step up to help former Neighborhood Health Care Inc. patients who had been treated at the health centers in Harrison and Norwood, Merz said.